Transfusions for trauma patients with severe bleeding are usually composed of three blood components: platelets, plasma and red blood cells (RBC). But debates have always raged on among the medical personnel in emergency care about the best ratio of blood components to be given to such patients.
A new study from the University of Texas Health Science Center showed that a blood transfusion with a balanced ratio of plasma, platelets, and RBCs were more likely to stop bleeding compared to a transfusion with a higher ratio of RBCs.
AdvertisementHowever, scientists found no major difference in mortality rates when comparing these two widely-used transfusion procedures.
Lead author Dr. John B. Holcomband his research team conducted a study involving 680 severely injured patients who arrived at one of their trauma centers. Patients who were predicted to require massive transfusion were randomly assigned to receive two widely-used procedures during active resuscitation, in addition to all local standard-of-care interventions.
One transfusion used a blood component ratio of one platelet, one plasma and one RBC (1:1:1) and other used a component ratio of one platelet, one plasma and two RBCs (1:1:2).
Despite the apprehension that the balanced blood ratio group might experience higher rates of multiple inflammatory-mediated issues such as sepsis, blood clots, infection and acute respiratory distress syndrome, no major differences were identified between the two treatment groups.
Results show that extensive loss of blood (exsanguination), which was the main cause of death within the first 24 hours after a serious injury to the body, was significantly decreased in the 1:1:1 group. This is approximately 9.2% vs 14.6% in 1:1:2 group. Also 86% patients achieved hemostasis, the stoppage of bleeding, in the 1:1:1 group compared to 78% in the 1:1:2 group.
Scientists concluded that clinicians should consider using a 1:1:1 transfusion protocol, given the lower percentage of deaths from exsanguination and their failure to find differences in safety.
"The transfusion should start with the initial units transfused while patients are actively bleeding, and then transitioning to laboratory-guided treatment once hemorrhage control is achieved. Future studies of hemorrhage control products, devices, and interventions should concentrate on the physiologically relevant period of active bleeding after injury and use acute complications and later deaths (24 hours and 30 days) as safety end points," the authors write.
The study was online in the Journal of the American Medical Association.
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